December 21, 2021

Omicron spread

Phone rings, door chimes, in comes omicron… And boy howdy is it. From about 3% of total US cases about ten days ago to 73% of US cases this past week as estimated by the CDC. It’s peaked so fast that there are some thoughts that as of today, it’s more than 90% of US cases. What does this mean in terms of practical purposes? A few things. First, omicron is better at infecting fully vaccinated and boosted individuals than previous strains so, even if you’ve had all your shots, the chances of picking up the virus, given it’s rapid spread, is not negligible. Fortunately, the clinical illness it causes in relatively healthy individuals with vaccine and booster seems to be fairly mild and not something that would require hospitalization. If you are vaccinated, and do get sick or test positive, current CDC guidelines remain that you should quarantine for ten days from first symptom. Some authorities are suggesting that it should be ten days or a negative rapid test (as these are starting to become more available) as a negative test suggests a non-infectious state but CDC guidelines haven’t accepted that as of yet. Omicron also seems to not respond well to the monoclonal antibody infusions that have been a mainstay of treatment of infected with more serious disease. I haven’t seen recent data to tell how well it responds to the new antiviral pills that are just coming on line.

As omicron has gone from rare to everywhere in the past few weeks (the magic of exponential numbers in action), we’re seeing a lot of hype and contradictory advice in the lay press. The president was on TV this afternoon advising people who were vaccinated to continue with their holiday plans while, at the same time, WHO was putting out recommendations that holiday plans be cancelled. Which is the correct advice? I suppose that depends on the goals. WHO is the better advice if we are trying to limit the spread and buy time. The president’s advice is better given the pandemic weary world we live in and all of the mental health and economic issues this generates. Local numbers are ticking up again with Alabama cases up about 50% from two weeks ago, hospitalizations up about 10% over the same period and the deaths remaining about the same, roughly a dozen a day. UAB hospital, the major referral center in the state has had a jump in hospitalizations from about 20-25 on the down side of the delta wave to about 35 today. It’s a far cry from the 300 patients at the peak last winter just as vaccine was beginning to roll out but everyone is just a bit apprehensive.

From what I can tell, the majority of the citizens of Alabama are completely over pandemic thinking and behavior change. Very few people are wearing masks indoors and tend to grumble if asked. Those that do are usually wearing them incorrectly well below their nasal passages. I wear one at work when interacting with patients, but not in office areas where we are all vaccinated, and I wear one indoors in shops and restaurants unless seated at a table. I haven’t been wearing one at the theater for Reindeer Monologues as it was a small cast and crew and we were all vaccinated. I am wearing one in rehearsals for 9 to 5 which is a much bigger production. I’m not especially worried about being around theater people and theater audiences as they are generally a vaccinated population. They know as long as the pandemic rages, theater is going to be problematic (witness the rapid closing of shows on Broadway and West End due to Covid in the company) and they want to do their part to restore a sense of normalcy.

What should the new normal be? To achieve it, we have to get over this rather lunatic vaccine hesitancy that’s plaguing the world and which continues to be used as a political tool. It would be easy to blame Trump but it’s much more complex than that, witness his crowd booing him when, at a recent rally, he suggested to his people that they take vaccines and booster shots. Coronaviruses are simple organisms, mutate quickly, and are not really amenable to herd immunity so letting it just wash over us is going to have a heavy human toll. Many variants on the common cold are coronaviruses and they’ve been around for millennia and we have yet to develop herd immunity to that. The only real weapon we have is a safe and effective vaccine. We’ve lost 800,000 people in this country to the disease. I can guarantee you that the number of people with complications even vaguely related to vaccination is a very small fraction of that. I don’t see why people hesitate at choosing between a disease that has a couple of percentage point chance of killing or permanently sickening you versus a vaccine where the chance of complication appears to be in the thousandths of a percentage point.

To achieve whatever new normal is, we’re going to have to vaccinate, and not just the US, but the world. All eight billion of us. The G20 and the other wealthy countries are going to have to put their heads together to figure out how to successfully vaccinate less functional and poorer countries or we’re going to continue playing whack a mole as new variants continue to pop up. We live in a global civilization these days. An easily transmissible variant that pops up in one country is on three different continents 24 hours later. It can’t be stopped without stopping intercontinental trade and transportation and we can’t have modern society with all of its conveniences without them. If this doesn’t happen, we’re going to be living with this pandemic for a few more years and my Accidental Plague Diaries may run to a number of volumes. If I publish additional volumes, I’ve thought I’d give each one a different color cover – and at current trends, the entire rainbow will be on your local library shelf before they’re done – including indigo.

My big fears with omicron are two. The first is that the spread is so fast and so many people become sick at once, that even if a relatively small percentage require hospital care, it still becomes an absolute number larger than the rickety US health care system can handle. We’re seeing that already in some states. Will that become the norm everywhere? Will it continue to drive my generation into early retirement and younger generations away from what should be fulfilling work but which has become so tainted with stress and societal disrespect that they either leave health professions or refuse to enter them in the first place? The second is that if omicron turns out to be less problematic than some of the doomsday hype being generated by the press, that the anti-public health forces will exploit the differences between predications and reality to further drive a wedge between public opinion and scientific expertise. This is going to be a huge problem when the next pandemic comes down the pike and it turns out to be much more lethal than Covid. We could very easily run into a filovirus such as Marburg or Ebola that jumps into human populations. These can have mortality rates as high as 90%. If one of those spreads rapidly internationally and we have a population indoctrinated into disbelieving public health measures and actively working against them as we do now, we will have no chance and our civilization will end. People will go on, but we won’t have the population and skills to maintain our way of life. And we wouldn’t be the first world civilization brought down by epidemic disease.

I’m still in a bit of a quandary over my planned trip to London next week. (I’m going to get whiny over my first world problems for a minute, so if you’re not interested, you can stop reading now). If the UK locks down or bans tourists, of course I don’t go because I can’t. But what if they don’t? Based on my trip to Portugal and Spain earlier this year, European populations are much more considerate of each other regarding mask wearing and social distancing than American ones. Omicron may be rampant there, but it’s just as rampant here so does it make any difference? I suppose the biggest risk is catching it on the plane across the pond or acquiring it in London making it difficult to get back into the US when the week is over. Still planning on going but watching the news and the statistics carefully. I would have no ill feelings about simply not getting on the plane at the last minute if that seemed like the best decision.

In the meantime, I have a Christmas tree to finally put up, cards to get in the mail, two more work days, a sheaf of notes to write, and a couple of work projects that need to be put to bed before I go. So, in the meantime, I’ll be kicking around home and office, wearing a mask out, keeping my hands washed. and getting Covid tested before going anywhere. If you haven’t gotten your booster yet, get it. Omicron is getting around two vaccines relatively easily but still has trouble with three.

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